Radiology Coding Alert
Billing Change for Breast Biopsies
Heads up, radiology and surgical oncology coders. coverage and billing is shifting, according to a Sept. 27, 2002, CMS program memorandum (AB-02-128).
For services provided on or after Jan. 1, 2003, Medicare will cover biopsy for a wider range of breast lesions. Radiographic nonpalpable lesions graded via Breast Imaging Reporting and Data System (BIRADS) as probably benign (III), suspicious (IV) or abnormality (V) will be covered. So will palpable lesions "that are difficult to biopsy using palpation alone." CMS leaves coverage for the types of palpable lesions up to the discretion of the carrier.
Applicable CPT Codes include:
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